Exam 2 Review

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Pennsylvania College of Health Sciences *

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205

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Mechanical Engineering

Date

Dec 6, 2023

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docx

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Uploaded by MasterBoulderHamster31

Exam 2 Review  Vents/ARDs o Why would someone require mechanical ventilation?  Respiratory failure (head injury, illness or disease that impairs gas exchange) o Nurse’s primary role before, during and immediately after intubation?  Gather needed supplies, help the pt to rinse their mouth, Pt education, make sure respiratory is there with ventilator, anesthesia is there. ** Main focus is the monitor patient for desaturation of O2, ensuring they are stopping to oxygenate the Pt**  Check placement after intubation  Watch for chest rise and fall, listen to bilateral breath sounds, auscultate epigastrium to ensure air is not entering the stomach  Check capnography  Chest x ray  Secure tube to the upper lip  Tube gets moved from one side of the mouth to the other once daily to minimize skin breakdown.  Also check measurement on tube to ensure the tube has not migrated or moved from placement.  Ventilator Modes to know:  Assist Control (AC) – ventilator provides breaths to the patient, when the patient takes a spontaneous breath, the machine will deliver the full ventilation to the patient. The machine can sense the patient is going to take a spontaneous breath.  Synchronized Intermittent Mechanical Ventilation (SIMV) – Allows the patient to take more shallow breaths in between machine delivered breaths. Not as supportive, more of a weaning mode.  Ventilator Settings to Know:  Respiratory Rate (RR)- respiratory rate can be adjusted based off the patient’s needs.  Tidal Volume – Volume of air that is pushed into the patient’s lungs with each machine delivered breath. Based on desired body weight, typically 6-8mL per kg (approx. 400- 500mL).  Can increase tidal volume if the pt needs to blow of CO2  Fraction of inspired oxygen (FiO2) – Amount of O2 delivered  RA O2 is approx. 21% O2  O2 is added via ventilator for pt.’s who need supplemental O2  Typically, 40-50% of FiO2 is delivered  ARDs patients will need much higher FiO2 o Example: Refractory hypoxemia  PEEP (Positive End Expiratory Pressure) – Keeps pressure on alveoli even on expiration to prevent alveolar collapse.  What 2 ventilator setting can be adjusted based off ABG’s to change……..  CO2 –  High – increase respiratory rate and tidal volume  Low – decrease respiratory rate and tidal volume  O2-

Obstructive Sleep Apnea (OSA):  Risk Factors o STOP BANG  S – Snoring  T- Tired during the day  O – Observed not breathing  P – Prescriptions (HTN Specifically)  B – BMI >35  A- Age >50y/o, also postmenopausal women  N- Neck circumference >30cm  G- Gender, male specifically o 3 or more = significantly increased risk  Symptoms associated w/OSA o Headache in the morning o Daytime drowsiness o Mood: Irritable, inability to cope, depressed o Dry mouth/sore throat in the morning o Restless sleep o Inability to focus  Risk associated w/OSA o Safety (work injuries, MVA r/t falling asleep while driving) o Stroke (CVA) r/t vasoconstriction that occurs o HTN o Insulin resistance (even when no DM) o Cardiac arrythmias (r/t lack of O2 and vasoconstriction)  Treatments o Main treatment – CPAP (continuous positive airway pressure)  COMPLIANCE IS THE BIGGEST ISSUE!!! o Other treatments  Dental devices  Weight loss  Surgery if related to enlarged uvula, tonsils, adenoids o If treatment is affective all symptoms will improve  Improved mood, less irritable, not depressed, able to cope  Ability to focus  Increased energy, decrease in daytime drowsiness, or eliminated all together  Decrease BP Laryngeal Cancer:  S&S of possible cx o Hoarse voice > than 2 weeks o Non-healing oral lesions (sensitive to hot or citrus) o Difficulty swallowing (dysphagia) o Feeling of a lump in the throat o Throat pain o May see red (erythroplakia) or white (leukoplakia) patches  Increased risk of cx in those who use tobacco and alcohol

 Post-op o Total Laryngectomy  No risk for aspiration r/t permanent separation of trachea and esophagus  They have a stoma  Complete loss of natural voice  Need to decide on alternative form of communication o Partial Laryngectomy  Maintains risk for aspiration r/t partial separation of trachea and esophagus  Sitting upright when eating  Careful method of swallowing  Speech evaluation  Eating food of appropriate consistency  Can maintain natural voice  Client Education: Stoma care at home o Do’s:  Water based lubricants  Clean with soap and water  Humidified home O2  Wear medical alert bracelet o Don’ts  Absolutely no swimming!  No Q-tips (can leave fibers behind in stoma)  No powder or spray in the area of the stoma (be careful)  Do not cover (this is Pt’s only airway)  Radical Neck Dissection o Invasive surgery- removal of muscle, nerves, lymph nodes in the neck and through shoulder on affected side. o Expected finding that will be a chronic issue:  Shoulder drop (due to removal of the accessory cranial nerve)  Will need to develop different muscles to have mobility in shoulder o Interprofessional team –  PT will be very important – will not resolve without PT intervention to develop other muscles  Dietary  Respiratory  Speech  ENTIRE TEAM IS IMPORTANT FOR DISCHARGE PLANNING Lung Cancer  Treatment for lung cancer is guided by staging of the cancer o Staging is determined by  Size of tumor  Lymph node involvement  Spread of the tumor (metastasis)  Bronchoscopy o Evaluate the actual lung tissue, can also do biopsy o Nursing responsibility w/bronchoscopy  Consent

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